Category II CPT Codes and Physician Performance Measures* (July 2010)

Why This Topic Matters

Understanding how performance measures are developed and reported helps organizations align quality reporting workflows with payer and accreditation expectations. It also provides context for the role of Category II CPT codes within physician quality initiatives and other reporting systems.

Article Sections

1. Performance Measures

   Introduces performance measures as a reporting framework and describes common ways data for physician quality measurement are captured.

2. Performance Measure Developers

   Summarizes the main organizations involved in developing physician performance measures and related reporting programs.

3. Performance Measure Endorsement

   Describes endorsement and consensus-based review of performance measures and the role of national organizations in that process.

4. Types of Performance Measures

   Reviews broad categories of performance measures and the general concepts used to assess care quality and accountability.

5. Elements of Performance Measures

   Explains the basic components that make up performance measures and how they are structured for reporting.

6. Coding Numerators and Denominators

   Covers how claims-based reporting uses coding elements tied to performance measure numerators and denominators.

7. Modifiers for Designating Exclusions

   Discusses the modifier framework used to indicate exclusions in quality-reporting contexts and the general reasons represented.

8. Category II CPT Code Development

   Outlines the development workflow for Category II CPT codes and the organizations involved in review and approval.